Rising China: Not at War with US

The rise of China is indeed no less than a miracle as the state has shown splendid economic growth in the period of few decades This rise has managed to attract the world wide attention While many in the contemporary world look at China as an opportunity the Western school of thought has portrayed it as nothing but a threat to the United States in particular Despite already having her allies in the region and a network of military bases other than the increasing economic relations with East Asian states United States has adopted measures to contain China China s behavior on the other hand shows that the state is more inclined towards the economic interdependence thereby creating a harmonious environment which will ensure world peace and stability Her regional policy shows that China not only wants to develop sound economic relations with all but also desires to sort out differences through dialogue and consensus China has by far avoided making alliances at both the regional and international level Furthermore China s growing economic relations with United States in particular point towards her peaceful ris

The knowledge and attitude regarding pubertal changes among adolescent males in urban Karachi, Pakistan

Background: Adolescence (the period between childhood and adulthood) is characterised by significant changes in bodily functions, along with psychological and cognitive growth. The unanticipated changes in that phase (especially related to sexuality) can cause adolescents embarrassment and distress, thus impacting their well-being and development.Purpose: The study aimed to evaluate the level of knowledge and attitudes among male adolescents residing in urban Karachi, Pakistan, specifically concerning pubertal changes and health. The primary focus was to gather information about how well these adolescents understand the physical and emotional transformations associated with puberty and their overall awareness and attitude towards pubertal health aspects.Method: This study follows a quantitative descriptive cross-sectional design. A total of 277 male adolescents were recruited through a stratified random sampling method four study sites, two private secondary schools and two government schools in urban Karachi, Pakistan. Data was collected by using a comprehensive researcher-constructed questionnaire that assessed their knowledge and attitude towards puberty and the source of pubertal information.Findings: The findings revealed that only 45.4% of students from private and 36% from public schools were acquainted with the knowledge of pubertal changes. Furthermore, a mixed level of awareness was observed among male adolescents in Karachi about puberty. While there was a basic awareness of the term puberty, especially among students attending public schools, the depth of knowledge and understanding of the associated changes during puberty was varied.Conclusion: The research showed that while there is a fundamental awareness of the concept of puberty, there is also a limited understanding of its complexities. Varied levels of comprehension among students from different educational settings emphasise the influence of environmental factors on adolescent awareness and emphasises the need for special educational initiatives to bridge the knowledge gap and prepare adolescents to navigate the complexities of puberty

Role of Surgery in locally advanced prostate cancer

A significant proportion of patients present with locally advanced prostate cancer with inherent higher risk of local recurrence and systemic relapse after initial treatment. Recent literature favors combination of radiation therapy and extended hormonal therapy for this subset of patients. The effectiveness of Radical prostatectomy (RP) alone for locally advanced prostate cancer is controversial and is a focus of debate. However, it can decrease the tumor burden and allows the accurate and precise pathological staging with the need for subsequent treatment. Comparison of RP and other treatment modalities is difficult and incorrect because of inherent selection bias. RP as a part of multi-modality treatment (with neo-adjuvant hormonal therapy (HT) and with adjuvant or salvage radiation therapy (RT)/HT) can provide long term overall and cancer specific survival. Surgical treatment (such as transurethral resection (TUR), JJ stenting and percutaneous nephrostomy (PCN) placement etc.) can also provide symptomatic improvement and palliative care to improve quality of life of patients with advanced prostate cancer

Simulation based team training in surgery - A review

The healthcare environment in surgery is complex, dynamic and often ambiguous. Besides subject knowledge and technical skills, other competencies, such as team work, communication skills and situation awareness, are required to ensure better patient-related outcome. Teams that demonstrate poor non-technical skills make more technical errors, often resulting in patient morbidity or mortality. Different hospital-based locations, such as operating rooms, intensive care units, emergency rooms and surgical wards, are the areas where poor team dynamics prevail. Simulation-based team training is a strategy to provide inter-professional training and experiential learning opportunities for surgeons, anaesthetists and allied health professionals. It helps them to effectively respond in complex situations in complex surgical environment. Simulation-based team training has 3 components; didactics, simulation itself, and debriefing. Literature has shown that simulation-based team training in surgery improves identification of team-based behaviours, improves team performance and overall patient safety

Surgeons and ethical challenges in operating room

Ethics lie in the heart of professionalism. In surgery, it represents an essential element, with surgeons facing ethical challenges in their routine practice. The rapid expansion of surgical technology and innovation along with the use of resources and consideration of conflict of interest have brought up the need for the development of current surgical code of ethics. Operating room represents a stressful environment where patients\u27 lives depend upon careful preparation, planning and execution. The progression of surgery within the operating room must be done in harmony and in line with the ethical principles of autonomy, beneficence, non-maleficence and justice. Discussion of ethical problems arising in the operating room is not a common subject in surgical literature. The current narrative review was planned to cover ethical concerns related to patients\u27 safety and privacy in the operating room and some of the evolving topics, like ethics of overlapping surgery, live surgical broadcast and \u27do not resuscitate\u27 policy in the operating room

Bayesian approach to classification of football match outcome

The football match outcome prediction particularly has gained popularity in recent years. It attract lots type of fan from the analyst expert, managerial of football team and others to predict the football match result before the match start.There are three types of approaches had been proposed to predict win, lose or draw; and evaluate the attributes of the football team. The approaches are statistical approach, machine learningapproach and Bayesian approach. This paper propose the Bayesian approaches within machine learning approaches such as Naive Bayes (NB), Tree Augmented Naive Bayes (TAN) and General Bayesian Network (K2) to predict the football match outcome. The required of football data is the English Premier League match results for three seasons; 2016 – 2017, 2015 – 2016 and 2014 – 2015 downloaded from http://www.football-data.co.uk. The experimental results showed that TAN achieved the highest predictive accuracy of 90.0 % in average across three seasons among others Bayesian approach (K2 and NB). The result from this research is hope that it can be used in future research for predicting the football match outcome

Frequency and predictors of recurrence of bladder tumour on first check cystoscopy - a tertiary care hospital experience

Abstract OBJECTIVE: To determine the frequency and predictors of non-muscle invasive bladder tumour recurrence on first-check cystoscopy after transurethral resection of bladder tumour. METHODS: This cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from April to November 2014, and comprised patients with a suspected newly-diagnosed urothelial cancer. Patients with non-muscle invasive disease with complete resection of all visible lesions along with deep biopsy from the tumour base were included. Patients received standard adjuvant intravesical therapy according to their risk stratification and underwent a white-light check cystoscopy at 3 months to look for tumour recurrence. Association between clinico-pathological variables and recurrence at first cystoscopy was determined. SPSS 20 was used for data analysis. RESULTS: The mean age of 84 patients at presentation was 63.3±12.5 years (range: 36-89 years). There were 75(89%) men and 9(11%) women. On initial transurethral resection, the size of tumour was less than 3cm in 32(38%) participants and equal to or above 3cm in 52(62%). Single tumour was found in 51(61%) subjects and multiple tumours in 33(39%). None of the resected tumours was primary carcinoma in situ and 35(42%) tumours were of high grade. The overall recurrence rate at first cystoscopy was 28(33.3%). Larger tumour, higher grade and tumour multifocality were factors associated with recurrence at check cystoscopy (p\u3c0.05 each). Patients\\u27 age, gender, smoking status and tumour stage did not correlate with early recurrence (p\u3e0.05 each). CONCLUSIONS: The number, size and grade of the tumour strongly correlated with recurrence at check cystoscopy

Role of multi-parametric (mp) MRI in prostate cancer

Multi-parametric magnetic resonance imaging is increasingly being recommended as standard imaging modality for prostate cancer diagnosis and staging. It comprises structural T2 and T1 sequences supplemented by functional imaging techniques, i.e. diffusion-weighted, dynamic contrast enhanced and spectroscopic imaging. Pre-biopsy multi-parametric magnetic resonance imaging is recommended for both detection and staging as it avoids biopsy artefact, and when normal, has a negative predictive value of 95% for significant cancer. Magnetic resonance imaging-guided prostate biopsy targets only area(s) considered to be suspicious for prostate cancer, hence resulting in improved accuracy. Dynamic contrast enhancing helps in the detection of cancer and for the assessment of extra-capsular extension, distal urethral sphincter and seminal vesicles involvement. The role of multi-parametric magnetic resonance imaging in follow-up of patients on active surveillance is also increasingly recognised. Its role is now further expanded to facilitate targeted therapies. This review focuses on the evolving role of multi-parametric magnetic resonance imaging in diagnosis and management of prostate cancer

Validation of updated partin’s table in Pakistani patients undergoing radical prostatectomy for prostate cancer

Objectives: To establish the usefulness and validity of 2007 Partin’s table in our population with prostate cancer. Materials and methods: Between January 1998 to June 2009, all patients with clinically localized carcinoma prostate who were treated with intent of radical retro-pubic prostatectomy (RRP) were included. Clinical, operative and pathological data was gathered. All biopsy and final histopathology Gleason scores were re-assigned in a double blind manner. Pre-operative serum PSA, TNM clinical stage and biopsy Gleason scores were plotted on Partin’s table and its predictive value and pathological findings of specimen were compared and analyzed by using Receiver operating characteristic (ROC) analysis. Results: A total of 109 of 138 patients were included in final analysis. The median age was 65 ± 5.8 years. The pre-operative serum PSA values and clinical stages were higher in our cohort of patients as compared to Partin’s cohort. At pathological assessment of resected specimen, organ confined disease was present in 58 % of patients, seminal vesicles were involved in 22 % and lymph node metastasis was present in 12 % of patients. The accuracy of Partin’s table derived probability was high with area under curve (AUC) of 0.82 for organ confinement, 0.805 for seminal vesicle involvement and 0.714 for lymph node involvement respectively. Conclusions: The 2007 Partin’s table has a reasonably high predictive value for the final histo-pathological features. This predictive model can be used in Pakistani patients with carcinoma prostate with comparable accuracy

Do individual disposition and occupational self-efficacy work? Threat of COVID-19 on banks frontline employees’ performance: An emerging market context

This study aims to analyze the divulgence of COVID-19 on individuals, institutions and institutional setups, evidence taken from banking sector of an emerging market of Pakistan. The study used, structured Questionnaire for the data collection purpose. The questionnaire was administered from the employees of banking sector of Pakistan. Total of 500 questionnaires were distributed having a 97% response rate. Analysis of the data was done using SPSS Process macro. Results show occupational self-efficacy positively affects the relationship of perceived threat of COVID-19 and employee performance. As the healthy work environment reduces the stress factor and helps in maximizing the performance outcome. Individual disposition further add the incremental factor as individual characteristics improve the employee performance specially and organizational performance generally. Current research provides input to the organizations like Banks; as to how they can minimize the perception of threat to improve the working of employees. It also provides useful human resource management practices to banking sector to control and decrease the effect of COVID-19 and such events. To the best of the author’s knowledge, this study is the first attempt to analyze the divulgence of COVID-19 on individuals, institutions and institutional setups and therefore provides a significant contribution to the occupational self-efficacy, individual disposition and COVID-19 literature